Timor-Leste

After several centuries of Portuguese colonial rule and 24 years of a brutal Indonesian military occupation, East Timor voted for independence in 1999. Following the vote, the Indonesian military led a wide-spread campaign of violence, leaving a large wake of death and destruction as they departed. It is estimated that 75% of the country’s infrastructure was destroyed. The United Nations provided administration for the country until 2002 when the new nation of Timor-Leste was formed.

Timor-Leste is a small, half-island nation of approximately 1.2 million people and is transitioning from a post-conflict environment to an environment of rebuilding local capacity across all sectors, including the health sector. While the urban capital city of Dili is home to an increasing number of Timorese, the majority of the population is still spread throughout the mountainous, rural interior of the country.

Health Alliance International (HAI) began working in Timor-Leste in 1999 when we sent a health and human rights delegation to assess the country’s human rights and health situation, and to develop a project for the delivery of essential maternal care services. After the establishment of the Timor-Leste Ministry of Health (MOH) in 2002, HAI has worked to support the MOH to rebuild the health system. Today our work focuses on strengthening the MOH’s maternal and child health services and integrating them into primary health care and generating demand for health services delivered through the public sector.

When HAI began our work, Timor had some of the worst maternal and child health outcomes in the Southeast Asian region. Community understanding of optimal health practices during pregnancy and delivery, such as knowledge of danger signs, benefits of a skilled birth attendant and other maternal care-seeking behaviors was limited. Although maternal health knowledge has improved and rates of skilled birth attendance have increased since independence in 2002, the current health system continues to face challenges to providing women with high quality skilled care at the time of delivery, particularly when complications arise. Additionally, there are significant disparities in accessing maternal services for the poorest women with low education levels who live largely in the rural areas of Timor-Leste.